U.S. patent application number 14/691026 was filed with the patent office on 2016-10-20 for femoral drill guide configured for outside-in drilling and inside-out reaming.
The applicant listed for this patent is Biomet C.V.. Invention is credited to Gregory Loren, Jason Meridew, Daniel Romano.
Application Number | 20160302805 14/691026 |
Document ID | / |
Family ID | 57128203 |
Filed Date | 2016-10-20 |
United States Patent
Application |
20160302805 |
Kind Code |
A1 |
Meridew; Jason ; et
al. |
October 20, 2016 |
FEMORAL DRILL GUIDE CONFIGURED FOR OUTSIDE-IN DRILLING AND
INSIDE-OUT REAMING
Abstract
A femoral drill guide assembly constructed in accordance to one
example of the present disclosure includes a handle portion, a
parallel slider, a perpendicular slider, a feeder guide and a
receiving guide. The handle portion can extend along a first plane
and include a first adjustable mating portion formed thereon. The
parallel slider can have a second and a third adjustable mating
portion thereon. The first and second adjustable mating portions
can selectively move relative to each other causing the parallel
slider to move relative to the handle portion between a plurality
of positions along the first plane. The perpendicular slider can
extend along a second plane and have a fourth adjustable mating
portion thereon. The third and fourth adjustable mating portions
can selectively move relative to each other causing the
perpendicular slider to move relative to the parallel slider
between a plurality of positions along the second plane.
Inventors: |
Meridew; Jason; (Warsaw,
IN) ; Romano; Daniel; (Warsaw, IN) ; Loren;
Gregory; (Encinitas, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Biomet C.V. |
Gibraltar |
|
GB |
|
|
Family ID: |
57128203 |
Appl. No.: |
14/691026 |
Filed: |
April 20, 2015 |
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/1714
20130101 |
International
Class: |
A61B 17/17 20060101
A61B017/17 |
Claims
1. A femoral drill guide assembly comprising: a handle portion that
extends along a first plane between a first handle end and an
opposite second handle end, the first handle end including a first
adjustable mating portion formed thereon; a parallel slider that
extends between a parallel slider first end and an opposite
parallel slider second end, the parallel slider having a second and
a third adjustable mating portion thereon, wherein the first and
second adjustable mating portions selectively move relative to each
other causing the parallel slider to move relative to the handle
portion between a plurality of positions along the first plane; a
perpendicular slider that extends along a second plane between a
perpendicular slider first end and an opposite perpendicular slider
second end, the perpendicular slider having a fourth adjustable
mating portion thereon, wherein the third and fourth adjustable
mating portions selectively move relative to each other causing the
perpendicular slider to move relative to the parallel slider
between a plurality of positions along the second plane; a feeder
guide movably coupled to the perpendicular slider and configured to
direct a guide wire; and a receiving guide coupled to the handle
portion and having a receiving end configured to accept the guide
wire from the feeder guide.
2. The femoral drill guide assembly of claim 1 wherein the
receiving end of the receiving guide is funnel shaped.
3. The femoral drill guide assembly of claim 2 wherein the
receiving guide comprises a first guide body portion that extends
along a first axis and a second guide body portion that extends
along a second axis, wherein the first and second guide body
portions converge at an intermediate non-linear body portion,
wherein the first and second axes intersect.
4. The femoral drill guide assembly of claim 3 wherein the
receiving guide is cannulated.
5. The femoral drill guide assembly of claim 1 wherein one of the
first and second adjustable mating portions comprises a first slot
and the other of the first and second adjustable mating portions
comprises a first locating member, wherein the first locating
member slidably negotiates along the first slot causing the
parallel slider to move relative to the handle portion between the
plurality of positions along the first plane.
6. The femoral drill guide assembly of claim 5 wherein the first
locating member collectively comprises a first screw that
threadably mates with a receiving disk, the first screw movable
between (i) a locked position with the disk wherein the first
locating member is fixed to the handle portion and (ii) an unlocked
position with the disk wherein the first locating member moves
along the first slot and the parallel slider moves relative to the
handle portion.
7. The femoral drill guide assembly of claim 6 wherein the first
slot is arcuately shaped along the handle portion.
8. The femoral drill guide assembly of claim 1 wherein one of the
third and fourth adjustable mating portions comprises a second slot
and the other of the third and fourth adjustable mating portions
comprises a second locating member, wherein the second locating
member slidably negotiates along the second slot causing the
perpendicular slider to move relative to the parallel slider
between the plurality of positions along the second plane.
9. The femoral drill guide assembly of claim 8 wherein the second
locating member collectively comprises a second screw that
threadably mates with a receiving member, the second screw movable
between (i) a locked position with the receiving member wherein the
second locating member is fixed to the perpendicular slider and
(ii) an unlocked position with the receiving member wherein the
second locating member moves along the second slot and the
perpendicular slider moves relative to the parallel slider.
10. The femoral drill guide assembly of claim 9 wherein the second
slot is arcuately shaped along the perpendicular slider.
11. The femoral drill guide assembly of claim 1 wherein the
receiving guide is rotatably fixed to the second handle end,
whereby the receiving guide selectively rotates along the second
axis.
12. The femoral drill guide assembly of claim 3 wherein the second
guide body portion of the receiving guide adjustably translates
along the second axis relative to the handle portion to locate the
receiving end at a plurality of positions.
13. The femoral drill guide assembly of claim 1 wherein the
parallel slider is arcuately shaped.
14. The femoral drill guide assembly of claim 1 wherein the
perpendicular slider is arcuately shaped.
15. A femoral drill guide assembly comprising: a handle portion
that extends along a first plane and including a first adjustable
mating portion formed thereon; a first adjustable member having a
second and a third adjustable mating portion formed thereon,
wherein the first and second adjustable mating portions selectively
move relative to each other causing the first adjustable member to
move relative to the handle portion between a plurality of
positions along the first plane; a second adjustable member that
extends along a second plane, the second adjustable member having a
fourth adjustable mating portion thereon, wherein the third and
fourth adjustable mating portions selectively move relative to each
other causing the second adjustable member to move relative to the
first adjustable member between a plurality of positions along the
second plane, the first and second planes being distinct; a feeder
guide movably coupled to the second adjustable member and
configured to direct a guide wire; and a receiving guide coupled to
the handle portion and having a funnel-shaped receiving end
configured to accept the guide wire from the feeder guide.
16. The femoral drill guide assembly of claim 15 wherein the
receiving guide comprises a first guide body portion that extends
along a first axis and a second guide body portion that extends
along a second axis, wherein the first and second guide body
portions converge at an intermediate non-linear body portion,
wherein the first and second axes intersect.
17. The femoral drill guide assembly of claim 15 wherein one of the
first and second adjustable mating portions comprises a first slot
and the other of the first and second adjustable mating portions
comprises a first locating member, wherein the first locating
member slidably negotiates along the first slot causing the first
adjustable member to move relative to the handle portion between
the plurality of positions along the first plane.
18. The femoral drill guide assembly of claim 17 wherein the first
locating member collectively comprises a first screw that
threadably mates with a receiving disk, the first screw movable
between (i) a locked position with the disk wherein the first
locating member is fixed to the handle portion and (ii) an unlocked
position with the disk wherein the first locating member moves
along the first slot and the first adjustable mating portion moves
relative to the handle portion.
19. The femoral drill guide assembly of claim 15 wherein one of the
third and fourth adjustable mating portions comprises a second slot
and the other of the third and fourth adjustable mating portions
comprises a second locating member, wherein the second locating
member slidably negotiates along the second slot causing the second
adjustable member to move relative to the first adjustable member
between the plurality of positions along the second plane.
20. The femoral drill guide assembly of claim 19 wherein the second
locating member collectively comprises a second screw that
threadably mates with a receiving member, the second screw movable
between (i) a locked position with the receiving member wherein the
second locating member is fixed to the second adjustable member and
(ii) an unlocked position with the receiving member wherein the
second locating member moves along the second slot and the second
adjustable member moves relative to the first adjustable
member.
21. The femoral drill guide assembly of claim 20 wherein the first
slot is arcuately shaped along the first adjustable member and the
second slot is arcuately shaped along the second adjustable
member.
22. A method of preparing a tunnel in a femur for receipt of an
anterior cruciate ligament (ACL) replacement graft using a femoral
drill guide assembly, the method comprising: grasping a handle
portion of the femoral drill guide assembly, the femoral drill
guide assembly further including (i) a parallel slider movably
coupled relative to the handle portion along a first plane, (ii) a
perpendicular slider movably coupled relative to the parallel
slider along a second plane, (iii) a feeder guide coupled to the
perpendicular slider, and (iv) a receiving guide coupled to the
handle portion; positioning a funnel-shaped structure extending
from a receiving guide onto a native ACL footprint; adjusting the
parallel slider relative to the handle portion along the first
plane; adjusting the perpendicular slider relative to the parallel
slider; locating the feeder guide at a desired location on a
femoral cortex of the femur based on the adjusting of the parallel
and perpendicular sliders; passing a pin through the feeder guide;
receiving the pin with the funnel-shaped structure on the receiving
guide; and drilling the tunnel based on the position of the
pin.
23. The method of claim 22 wherein adjusting the parallel slider
comprises: slidably negotiating a first locating member disposed on
one of the parallel slider and the handle portion along a first
arcuate slot formed in the other of the parallel slider and the
handle portion.
24. The method of claim 23 wherein adjusting the perpendicular
slider comprises: slidably negotiating a second locating member
disposed on one of the perpendicular slider and the parallel slider
along a second arcuate slot formed in the other of the
perpendicular slider and the parallel slider.
Description
FIELD
[0001] The present disclosure relates generally to a method and
apparatus for use in performing ACL reconstruction, and more
particularly to a method and apparatus including a drill guide
assembly that is adjustable in two distinct planes.
BACKGROUND
[0002] The background description provided herein is for the
purpose of generally presenting the context of the disclosure. Work
of the presently named inventors, to the extent it is described in
this background section, as well as aspects of the description that
may not otherwise qualify as prior art at the time of filing, are
neither expressly nor impliedly admitted as prior art against the
present disclosure.
[0003] An anterior cruciate ligament (ACL) interconnects a portion
of the tibia with a portion of the femur. Although the natural and
healthy anatomy generally is able to support the various portions
of the anatomy with natural ligaments and tendons such as the ACL,
injury, disease, age or other circumstances may cause weakening or
breaking of the ACL requiring surgical intervention. The breaking
or weakening of the tissue may require the tissue to be reconnected
or replaced with various autografts or xenografts that may be made
of natural or synthetic materials. These various materials are
generally interconnected with selected portions of the anatomy
using screws or other similar friction or obstruction holding
devices. Typically a surgeon prepares a tunnel in the femur for
receipt of the replacement ligament. Correct location of such a
femoral tunnel is critical to surgical success. While many
instruments available are satisfactory for their intended purpose,
it would be desirable to provide a femoral drill guide that offers
greater adjustability such that a surgeon can first identify the
optimal position of the femoral tunnel and subsequently use the
femoral drill guide to assist in preparing that femoral tunnel in a
minimally invasive manner.
SUMMARY
[0004] This section provides a general summary of the disclosure,
and is not a comprehensive disclosure of its full scope or all of
its features.
[0005] A femoral drill guide assembly constructed in accordance to
one example of the present disclosure includes a handle portion, a
parallel slider, a perpendicular slider, a feeder guide and a
receiving guide. The handle portion can extend along a first plane
between a first handle end and an opposite second handle end. The
first handle end can include a first adjustable mating portion
formed thereon. The parallel slider can extend between a parallel
slider first end and an opposite parallel slider second end. The
parallel slider can have a second and a third adjustable mating
portion thereon. The first and second adjustable mating portions
can selectively move relative to each other causing the parallel
slider to move relative to the handle portion between a plurality
of positions along the first plane. The perpendicular slider can
extend along a second plane between a perpendicular slider first
end and an opposite perpendicular slider second end. The
perpendicular slider can have a fourth adjustable mating portion
thereon. The third and fourth adjustable mating portions can
selectively move relative to each other causing the perpendicular
slider to move relative to the parallel slider between a plurality
of positions along the second plane. The feeder guide can be
movably coupled to the perpendicular slider and be configured to
direct a guide wire. The receiving guide can be coupled to the
handle portion and have a receiving end configured to accept the
guide wire from the feeder guide.
[0006] According to additional features, the receiving end of the
receiving guide is funnel-shaped. The receiving guide can comprise
a first guide body portion that extends along a first axis and a
second guide body portion that extends along a second axis. The
first and second guide body portions can converge at an
intermediate non-linear body portion. The first and second axes
intersect. The receiving guide can be cannulated.
[0007] According to other features, one of the first and second
adjustable mating portions comprises a first slot. The other of the
first and second adjustable mating portions comprises a first
locating member. The first locating member can slidably negotiate
along the first slot causing the parallel slider to move relative
to the handle portion between the plurality of positions along the
first plane. The locating member can collectively comprise a first
screw that threadably mates with the receiving disk. The first
screw is movable between (i) a locked position with the disk
wherein the first locating member is fixed to the handle portion
and (ii) an unlocked position with the disk wherein the first
locating member moves along the first slot and the parallel slider
moves relative to the handle portion. The first slot is arcuately
shaped along the handle portion.
[0008] In other features, one of the third and fourth adjustable
mating portions comprises a second slot and the other of the third
and fourth adjustable mating portions comprises a second locating
member. The second locating member slidably negotiates along the
second slot causing the perpendicular slider to move relative to
the parallel slider between the plurality of positions along the
second plane. The second locating member can collectively comprise
a second screw that threadably mates with a receiving member. The
second screw can be movable between (i) a locked position with the
receiving member wherein the second locating member is fixed to the
perpendicular slider and (ii) an unlocked position with the
receiving member wherein the second locating member moves along the
second slot and the perpendicular slider moves relative to the
parallel slider. The second slot is arcuately shaped along the
perpendicular slider. The receiving guide is rotatably fixed to the
second handle end whereby the receiving guide selectively rotates
along the second axis. The second guide body portion of the
receiving guide can adjustably translate along the second axis
relative to the handle portion to locate the receiving end at a
plurality of positions. The parallel slider can be arcuately
shaped. The perpendicular slider can be arcuately shaped.
[0009] A femoral drill guide assembly constructed in accordance to
another example of the present disclosure can include a handle
portion, a first adjustable member, a second adjustable member, a
feeder guide and a receiving guide. The handle portion can extend
along a first plane and include a first adjustable mating portion
formed thereon. The first adjustable member can have a second and a
third adjustable mating portion formed thereon. The first and
second adjustable mating portions selectively move relative to each
other causing the first adjustable member to move relative to the
handle portion between a plurality of positions along the first
plane. The second adjustable member can extend along a second plane
and have a fourth adjustable mating portion thereon. The third and
fourth adjustable mating portions can selectively move relative to
each other causing the second adjustable member to move relative to
the first adjustable member between a plurality of positions along
the second plane. The first and second planes are distinct. The
feeder guide can be movably coupled to the second adjustable member
and be configured to direct a guide wire. The receiving guide can
be coupled to the handle portion and have a funnel-shaped receiving
end configured to accept the guide wire from the feeder guide.
[0010] According to other features, the receiving guide can include
a first guide body portion that extends along a first axis and a
second guide body portion that extends along a second axis. The
first and second guide body portions can converge at an
intermediate non-linear body portion. The first and second axes
intersect. One of the first and second adjustable mating portions
comprises a first slot. The other of the first and second
adjustable mating portions comprises a first locating member. The
first locating member can slidably negotiate along the first slot
causing the first adjustable member to move relative to the handle
portion between the plurality of positions along the first plane.
The first locating member can collectively comprise a first screw
that threadably mates with a receiving disk. The first screw is
movable between (i) a locked position with the disk wherein the
first locating member is fixed to the handle portion and (ii) an
unlocked position with the disk wherein the first locating member
moves along the first slot and the first adjustable mating portion
moves relative to the handle portion.
[0011] According to other features, one of the third and fourth
adjustable mating portions includes a second slot. The other of the
third and fourth adjustable mating portions includes a second
locating member. The second locating member slidably negotiates
along the second slot causing the second adjustable member to move
relative to the first adjustable member between the plurality of
positions along the second plane. The second locating member can
collectively comprise a second screw that threadably mates with a
receiving member. The second screw is movable between (i) a locked
position with the receiving member wherein the second locating
member is fixed to the second adjustable member and (ii) an
unlocked position with the receiving member wherein the second
locating member moves along the second slot and the second
adjustable member moves relative to the first adjustable member.
The first slot is arcuately shaped along the first adjustable
member and the second slot is arcuately shaped along the second
adjustable member.
[0012] A method of preparing a tunnel in a femur for receipt of an
anterior cruciate ligament (ACL) replacement graft using a femoral
drill guide assembly is provided. The method includes grasping a
handle portion of the femoral drill guide assembly. The femoral
drill guide assembly can include (i) a parallel slider movable
coupled relative to the handle portion along a first plane (ii) a
perpendicular slider movably coupled relative to the parallel
slider along a second plane, (iii) a feeder guide coupled to the
perpendicular slider, and (iv) a receiving guide coupled to the
handle portion.
[0013] A funnel-shaped structure extending from a receiving guide
is positioned onto a native ACL footprint. The parallel slider is
adjusted relative to the handle portion along the first plane. The
perpendicular slider is adjusted relative to the parallel slider.
The feeder guide is located at a desired location on a femoral
cortex of the femur based on the adjusting of the parallel and
perpendicular sliders. A pin is passed through the feeder guide.
The pin is received with the funnel-shaped structure on the
receiving guide. The tunnel is drilled based on the position of the
pin.
[0014] According to other features, adjusting the parallel slider
includes slidably negotiating a first locating member disposed on
one of the parallel slider and the handle portion along a first
arcuate slot formed in the other of the parallel slider and the
handle portion. Adjusting the perpendicular slider includes
slidably negotiating a second locating member disposed on one of
the perpendicular slider and the parallel slider along a second
arcuate slot formed in the other of the perpendicular slider and
the parallel slider.
[0015] Further areas of applicability of the present disclosure
will become apparent from the description provided hereinafter. The
description and specific examples in this summary are intended for
purposes of illustration only and are not intended to limit the
scope of the present disclosure.
DRAWINGS
[0016] The present teachings will become more fully understood from
the detailed description, the appended claims and the following
drawings. The drawings are for illustrative purposes only and are
not intended to limit the scope of the present disclosure.
[0017] FIG. 1 is a first perspective view of a femoral ACL drill
guide assembly configured for outside-in drilling and inside-out
reaming and constructed in accordance to one example of the present
disclosure;
[0018] FIG. 2 is a second perspective view of the femoral ACL drill
guide assembly of FIG. 1;
[0019] FIG. 3 is an exploded view of the femoral ACL drill guide
assembly of FIG. 1;
[0020] FIG. 4 is a perspective view of a receiving guide of the
femoral ACL drill guide assembly of FIG. 1;
[0021] FIG. 5 is a front view of the femoral ACL drill guide
assembly of FIG. 1 and shown with a parallel slider adjustable
along a first plane;
[0022] FIG. 6 is a side view of the femoral ACL drill guide
assembly of FIG. 1 and shown with a perpendicular slider adjustable
along a second plane;
[0023] FIG. 7 is a lateral view of a left knee showing the femoral
ACL drill guide assembly positioned for outside-in drilling;
[0024] FIG. 8 is an anterior view of the left knee of FIG. 7
showing an exemplary femoral aimer drilling a femoral tunnel along
an inside-out path through the lateral femoral cortex; and
[0025] FIG. 9 is an anterior view of the left knee of FIG. 8
showing a reamer preparing a counterbore along the prepared femoral
tunnel; and
[0026] FIG. 10 is an anterior view of the left knee of FIG. 9
showing an exemplary ToggleLoc.TM. femoral fixation device using a
ZipLoop.TM. for ACL reconstruction.
DETAILED DESCRIPTION
[0027] The following description is merely exemplary in nature and
is not intended to limit the present disclosure, its application,
or uses. Examples are provided so that this disclosure will be
thorough, and will fully convey the scope to those who are skilled
in the art. Numerous specific details are set forth such as
examples of specific components, devices, systems and/or methods,
to provide a thorough understanding of the present disclosure. It
will be apparent to those skilled in the art that specific details
need not be employed, that examples shown herein may be embodied in
many different forms and that neither should be construed to limit
the scope of the disclosure.
[0028] The present teachings and related discussion are directed
primarily to a femoral ACL drill guide assembly used to prepare a
femoral tunnel for ACL fixation. It will be appreciated, however,
that the femoral ACL drill guide assembly may be used in other
procedures to prepare a tunnel in other bones and the following
description is not intended to be limiting to preparation of a
femoral tunnel for ACL reconstruction.
[0029] With initial reference to FIGS. 1-3, a femoral drill guide
assembly constructed in accordance to one example of the present
disclosure is shown and generally identified at reference numeral
10. As will become appreciated from the following discussion, the
femoral drill guide assembly 10 is particularly suited to allow for
outside-in drilling (from the outside lateral cortex of the femur
into the intercondylar notch) and inside-out reaming (from the
intercondylar notch toward the outside lateral cortex). In
particular, the femoral drill guide assembly 10 allows for
adjustment in two planes. Moreover, the femoral drill guide
assembly 10 provides structure to direct a guide wire inserted from
the outside lateral cortex of the femur, into the intercondylar
notch and out of a skin incision adjacent to the patella.
[0030] The femoral drill guide assembly 10 can generally include a
handle portion 12, a parallel slider 20, a perpendicular slider 22,
a feeder guide 30 and a receiving guide 32. The handle portion 12
can extend along a first plane 36 between a first handle end 40 and
an opposite second handle end 42. The first handle end 40 can
include a first adjustable mating portion 44 formed thereon. The
handle portion 12 is generally arcuately shaped. The first
adjustable mating portion 44 can be defined by a first slot 46
formed in the handle portion 12. The first slot 46 can be arcuately
shaped and provided near the first handle end 40. The first slot 46
can terminate at a catch 48 at the first handle end 40. The catch
48 can act as a stop at one end of the handle portion 12 that
corresponds to maximum travel of the parallel slider relative to
the handle portion 12.
[0031] A locating hub 50 can be provided at the second handle end
42. The locating hub 50 can further include a first arcuate inset
52 and a second arcuate inset 54 (FIG. 3). A central passage 56 can
be formed through the locating hub 50 in a direction generally
perpendicular to the first plane 36. A locking assembly 60 (FIG. 3)
can cooperate with the locating hub 50 for adjustably locking the
receiving guide 32 to the handle portion 12. The locking assembly
60 can include a threaded screw 64 and receiving nut 66. The
receiving nut 66 can include a threaded female portion 70 that
threadably receives the threaded screw 64. The receiving nut 66 can
be partially received by the central passage 56 of the locating hub
50.
[0032] The receiving nut 66 can further include an opening 74 that
slidably receives the receiving guide 32. Rotation of the threaded
screw 64 in a tightening direction causes the receiving nut 66 to
be further urged into the central passage 56 resulting in the
receiving guide 32 to be incrementally fixed against the locating
hub 50 at the first arcuate inset 52. The receiving guide 32 can
therefore be adjustably secured in a linear direction along its
axis and rotatably adjusted around an axis defined by the central
passage 56. In this regard, the receiving guide 32 may be
positioned at a plurality of locations and orientations relative to
the handle portion 12.
[0033] With continued reference to FIGS. 1-3 and further reference
to FIG. 5, the parallel slider 20 will be further described. The
parallel slider 20 generally extends between a parallel slider
first end 80 and an opposite parallel slider second end 82. The
parallel slider 20 can have a second adjustable mating portion 86
and a third adjustable mating portion 88. The first adjustable
mating portion 44 of the handle portion 12 and the second
adjustable mating portion 86 of the parallel slider 20 selectively
move relative to each other causing the parallel slider 20 to move
relative to the handle portion 12 between a plurality of positions
along the first plane 36 (FIG. 5).
[0034] The parallel slider 20 can include outer grooves 90 and 92
(FIG. 3) configured to slidably receive the handle portion 12 near
the first slot 46. The handle portion 12 generally tracks along the
grooves 90, 92 during adjustment of the parallel slider 20 along
the first plane 36. The first end 80 of the parallel slider 20
defines a passage 98. The second adjustable mating portion 86
comprises a first locating member 100. The first locating member
100 can collectively comprise a first screw 102 that threadably
mates with a receiving disk 104. The first screw 102 is received by
the passage 98 and is movable between a locked position and an
unlocked position. In the locked position the first locating member
100 is fixed to the handle portion 12. In the unlocked position,
the first locating member 100 moves along the first slot 46 and the
parallel slider 20 moves relative to the handle portion 12. The
second end 82 of the parallel slider 20 includes a pair of outer
arms 120 and a locating boss 122.
[0035] With continued reference to FIGS. 1-3 and further reference
to FIG. 6, the perpendicular slider 22 will be further described.
The perpendicular slider 22 generally extends along a second plane
130 between a perpendicular slider first end 132 and an opposite
perpendicular slider second end 134. A second slot 136 can be
defined through the perpendicular slider 22. The perpendicular
slider 22 can have a fourth adjustable mating portion 138 thereon.
In the example shown, the fourth adjustable mating portion 138 is
the second slot 136. The third adjustable mating portion 88 of the
parallel slider 20 and the fourth adjustable mating portion 138 of
the perpendicular slider 122 selectively move relative to each
other causing the perpendicular slider 22 to move relative to the
parallel slider 20 between a plurality of positions along the
second plane 130 (FIG. 6). In the example provided, the first plane
36 is perpendicular to the second plane 130 allowing adjustment
along two transverse planes. It will be appreciated, however, that
the femoral drill guide assembly 10 may be configured such that the
first plane 36 and second plane 130 are not transverse while still
allowing adjustment along two distinct planes.
[0036] The third adjustable mating portion 88 comprises a second
locating member 150 (FIG. 3). The second locating member 150 can
collectively comprise a second screw 152 that threadably mates with
a receiving member 156 defined in the boss 122. The second screw
152 extends through the second slot 136 and selectively mates with
the receiving member 156 between a locked position and an unlocked
position. In the locked position, the perpendicular slider 22 is
fixed to the parallel slider 20. In the unlocked position, the
second locating member 150 moves along the second slot 136 and the
perpendicular slider 22 moves relative to the parallel slider 20.
The boss 122 is guided along the second slot 136 while the outer
arms 120 of the parallel slider 20 bound the perpendicular slider
22. The slider second end 134 includes a receiving channel 158
configured to locate the feeder guide 30.
[0037] The feeder guide 30 will now be described in greater detail.
The feeder guide 30 generally includes a longitudinal feeder guide
body 160 that extends along a feeder guide body axis 161 (FIG. 3)
between a distal locating end 162 and a proximal adjusting end 164.
The longitudinal feeder guide body 160 includes ribs 170 thereon.
The feeder guide 30 is adjustable secured at the receiving channel
158 and translatable within the receiving channel 158 along the
feeder guide body axis 161. The feeder guide 30 defines a
cannulation 172 through the feeder guide body 160.
[0038] With general reference to FIGS. 1-3 and particular reference
to FIG. 4, the receiving guide 32 will be described in greater
detail. The receiving guide 32 includes a receiving end 180 and an
opposite end 182. The receiving guide 32 has a first guide body
portion 190 that extends along a first axis 192 and a second guide
body portion 194 that extends along a second axis 196. The second
guide body portion 194 defines a cannulation 197. The first and
second guide body portions 190 and 194 converge at an intermediate
non-linear body portion 198. The first axis 192 and the second axis
196 intersect. The receiving guide 32 can be adjustably secured to
the second handle end 42 at the locating hub 50. The receiving
guide 32 can therefore be adjustably secured in a linear direction
along and around the axis 196. In this regard, the receiving guide
32 may be positioned at a plurality of locations and orientations
relative to the handle portion 12.
[0039] The receiving end 180 includes a generally conical structure
200 and is generally funnel shaped. As will become appreciated
herein, the funnel-shaped nature of the receiving end 180 allows a
guide wire passed from the feeder guide 30 to be successfully
received by the conical structure 200 from a number of different
orientations. A guide wire received by the conical structure 200
can be slidably directed along an inner surface of the intermediate
portion 198 and into the cannulation 197 of the second guide body
portion 194. Because the conical structure 200 acts as a funnel,
the aim of the guide wire need not be with elevated precision.
Rather, the conical structure 200 can slidably guide the guide wire
from an area defined generally by the perimeter of the conical
structure 200 and into the receiving guide 32. The conical
structure 200 of the receiving end 180 acts as an aid for
arthroscopic visualization of the graft footprint prior to
drilling. Moreover, the radial range of motion of the feeder guide
30 allows it to remain in-line with the conical structure 200 of
the receiving end 180 of the receiving guide 32 while also allowing
a surgeon to urge the feeder guide 30 up against the outer surface
of the femur (see also FIG. 7) during drilling.
[0040] An exemplary method of using the femoral drill guide
assembly 10 will now be described with reference to FIG. 7. Because
the femoral drill guide assembly 10 provides adjustment in two
planes (plane 36, FIG. 5 and plane 130, FIG. 6), the range of
motion of the femoral drill guide assembly 10 allows for almost
unlimited drill placement options on femur 220 without sacrificing
footing on femoral condyle 222. This large range of motion
mitigates the guide's physical limitations as a factor in drill
placement. In this regard, the versatility of the femoral drill
guide assembly 10 allows the surgeon to choose drill placement on
the sole basis of creating the hole in the anatomic location that
provides the highest quality bone. Prior art single plane
"outside-in" reamers can create complicated coordinate systems
because they often must be rotated out of plane with respect to the
joint line to reach the desired drilling location. Even when
rotated out of plane, such prior art single plane instruments still
have a limited range of motion that limits socket placement
options. Similarly, a prior art inter-articular (inside-out)
approach to guide wire placement is often inaccurate. The femoral
drill guide assembly 10 provides greater adjustability to improve
upon these prior art limitations.
[0041] In other benefits, the femoral drill guide assembly 10
provides a simpler coordinate system over prior art drill guide
configurations. Explained further, current single-planar drill
guide options force the surgeon to rotate the drill guide
out-of-plane to get higher up (superior) on the femur 220, giving
the surgeon a complicated coordinate system with which to locate
the correct drilling location. The dual-planar, on-point range of
motion allows the surgeon to hold the handle portion 12 parallel to
the joint line and easily locate the correct drill location by
using the angular set of coordinates on each one of the sliding
portions of the femoral drill guide assembly 10. In this way, a
simple perpendicular-axis coordinate system is provided by the
femoral drill guide assembly 10. Further, as identified above, the
conical structure 200 of the receiving end 180 of the receiving
guide 32 allows for arthroscopic visualization of the graft
footprint before drilling.
[0042] In one exemplary method of using the femoral guide assembly
10, the surgeon first assesses and prepares the distal femur 220.
In this regard, the native ACL footprint can initially be
determined after excising the damaged ACL. The conical structure
200 of the receiving guide 32 can be placed on the native ACL
footprint. In some patients it may be desired to further assess the
posterior cruciate ligament (PCL). If there is not sufficient space
to accommodate a new ACL, it may be necessary to remove some of the
bone within the intercondylar notch to allow for enough space for
the new ACL to be placed without impingement.
[0043] Once the conical structure 200 of the receiving guide 32 is
located, the parallel slider 20 may be adjusted relative to the
handle portion 12 along the plane 36 (again see FIG. 5).
Additionally, the perpendicular slider 22 may be adjusted relative
to the parallel slider 20 along the plane 130 (again see FIG. 6).
Of note, the movement of the perpendicular slider 22 allows the
surgeon to locate more superiorly on the femoral cortex 230 to
reach thicker, more desirable cortical bone. The adjustments on
both planes 36 and 130 are made until the surgeon finds a desirable
location on the lateral cortex 230 where the distal end 162 of the
feeder guide 30 is placed.
[0044] The feeder guide 30 is then ratcheted tightly against the
lateral cortex 230 and a guide pin 234 is drilled in through the
lateral cortex 230 ("outside-in" as referred to herein). The guide
pin 234 is received by the conical structure 200 of the receiving
guide 32. In some examples, the guide pin 234 can be passed through
the cannulation 197 of the receiving guide 32 and come out of a
medial skin incision adjacent the patella. The guide pin 234 is
formed of flexible material such as Nitinol.
[0045] Referencing now FIGS. 8 and 9, the femoral drill guide
assembly 10 can then be removed. A reamer 250 can then be used to
drill over the guide pin 234 extending along the prepared femoral
tunnel from inside the joint space and out through the lateral
cortex 230 ("inside-out" as referred to herein) The reamer 250 can
be located through a medial incision adjacent the patella (not
specifically shown). In one example, a 4.5 mm reamer can be used.
Once an initially reamed femoral tunnel 254 has been prepared, the
reamer 250 is removed and a larger diameter second reamer 260 is
used to prepare a counterbore 256. Depending on the size of graft
used, the reamer 260 can be between 6 mm to 12 mm in diameter.
Other sizes are contemplated. In one example the second reamer 260
is drilled to a 25 mm depth. The second reamer 260 can have a
flexible section represented by crosshatching in FIG. 9. Other
configurations are contemplated.
[0046] Turning now to FIG. 10, an exemplary suspensory fixation
implant 270 can be implanted into the prepared tunnel. In the
example shown, the suspensory fixation implant 270 is a
ToggleLoc.TM. femoral fixation device having a ZipLoop.TM..
Additional description of the suspensory fixation implant 270 and
other suitable implants may be found in commonly owned U.S. Pat.
No. 8,740,939, the contents of which are expressly incorporated
herein by reference.
[0047] While one or more specific examples or aspects have been
described and illustrated, it will be understood by those skilled
in the art that various changes may be made and equivalence may be
substituted for elements thereof without departing from the scope
of the present teachings as defined in the claims. Furthermore, the
mixing and matching of features, elements and/or functions between
various examples may be expressly contemplated herein so that one
skilled in the art would appreciate from the present teachings that
features, elements and/or functions of one example may be
incorporated into another example as appropriate, unless described
otherwise above. Moreover, many modifications may be made to adapt
a particular situation or material to the present teachings without
departing from the essential scope thereof.
[0048] The terminology used herein is for the purpose of describing
particular example implementations only and is not intended to be
limiting. As used herein, the singular forms "a," "an," and "the"
may be intended to include the plural forms as well, unless the
context clearly indicates otherwise. The term "and/or" includes any
and all combinations of one or more of the associated listed items.
The terms "comprises," "comprising," "including," and "having," are
inclusive and therefore specify the presence of stated features,
integers, steps, operations, elements, and/or components, but do
not preclude the presence or addition of one or more other
features, integers, steps, operations, elements, components, and/or
groups thereof. The method steps, processes, and operations
described herein are not to be construed as necessarily requiring
their performance in the particular order discussed or illustrated,
unless specifically identified as an order of performance. It is
also to be understood that additional or alternative steps may be
employed.
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